Membership Form

Please enter my membership in Bermuda Cancer and Health Centre, fees will go towards our goal of raising $750,000 to upgrade diagnostic equipment and patient support systems; thereby increasing early cancer detection and decreasing the time between screening and diagnosis.

Upon completion of this form you will be taken to the payment page.

All fields marked with a star are mandatory

Membership Form

Type of MembershipAnnual_Member $15 Life_Member $100
TitleDr Mr Mrs Miss Ms Lady Other
First Name
Last Name
Email Address
Home Phone Number
Work Phone Number
Cell Phone Number
Fax Number

I would like to receive the Bermuda Cancer and Health Newsletter

Mailing Address

PO Box
Building Name
Street Address
Parish
Post Code

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